In mammaplasty achieving an aesthetic shape with the shortest scar possible and longest-lasting results has been the aim of most plastic surgeons. However, no single technique can accomplish all these goals. A great variety of surgical techniques are available. Vertical scar mammaplasty has allowed a significant reduction of scar length by eliminating the horizontal scar, with less resection of skin. As most vertical scar mammaplasties rely on the support of the skin envelope, a greater incidence of recurrent ptosis of the breast and healing problems in the vertical scar, such as wound dehiscence, is expected. To prevent these problems, some authors use additional measures that include fixation of the remaining gland to the pec-toralis fascia with several sutures [10,11], dermal suspension techniques , and even alloplastic mesh .
The lozenge technique is based on the skin markings of Arie , Peixoto's concept of tissue retraction [13,14], and the inferiorly based pedicle. The major component of this technique and the main difference from the other techniques is the use of the inferiorly based flap called the inferior pedicle that provides good suspension for the breast as it is fixed on the pec-toralis muscle and fascia, reducing the effect of gravitational pull, with better and longer-lasting results. It also provides bulk and natural fullness superiorly and inferiorly (Figs. 11.17,11.18). Another point of concern is avoiding the extension of the vertical scar beyond the submammary sulcus. This is done by marking point D 3.0 cm above the sulcus.
Although we have had no complaints about loss of breast sensation, especially of the nipple-areola complex, a decrease in the vibration and temperature sensibility of the nipple-areola complex, particularly after large reductions, is expected . It is important to keep an eye out during the surgery for the presence of a dog ear in the inferior pole of the breast, especially at the inferior end of the vertical scar, to avoid the
need for secondary revision. The technique has proved safe with respect to viability of the tissues, especially the nipple-areola complex and the inferior pedicle.
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